Biopsychosocial impact of prostate cancer and androgen-deprivation therapy

Abstract

Introduction: Prostate cancer is the most non-cutaneous malignancy in men, and androgen-deprivation therapy (ADT) is a cornerstone of management in advanced disease. The aim of this study was to evaluate the association of ADT with changes in depression and mental and physical quality of life (QoL) within a prospective patient cohort design. Methods: Patients were prospectively recruited and consented at a single academic health sciences centre in Ontario, Canada. Inclusion criteria included those men with adenocarcinoma of the prostate and either on watchful waiting or initiating ADT as palliation or as an adjuvant therapy for high-risk localized disease. All three cohorts were followed in routine care and completed psychosocial evaluations, including depression, social support, anxiety, and QoL measures. Results: In comparison to the control cohort of patients with prostate cancer on watchful waiting, initiation of ADT over a two-year period of time was not associated with any changes in depression or mental QoL. Instead, all patients, regardless of treatment cohort, showed increased depression scores and reduced mental QoL scores over time; however, for patients receiving ADT, a significant reduction in physical QoL compared to patients who did not receive ADT was demonstrated. Conclusions: ADT does not appear to significantly impact depressive symptoms and mental QoL over a two-year period; however, the depressive symptoms in this limited sample of men with prostate cancer was higher than expected and monitoring for these may be advisable for those who care for such patients. IntroductionProstate cancer is the most common non-cutaneous malignancy and the second leading cause of cancer-related death of men in North America.1 Androgen-deprivation therapy (ADT) remains a cornerstone of management of advanced disease; ADT improves survival when used in combination with radiotherapy in men with high-risk localized cancer, and represents standard palliation for men with incurable disease.2-4 Despite the cancer-related benefits, ADT has been well-shown to be associated with short-and long-term adverse effects, including sexual dysfunction, fatigue, hot flashes, osteoporosis, and cardiovascular complications.5 There is increasing evidence that ADT may also impact the psychological well-being of prostate cancer patients; 6,7 however, there are conflicting results in the literature as to the impact of ADT on depression. Many studies that have implicated ADT in depression either did not use validated depression-specific questionnaires or did not include control groups with patients suffering from prostate cancer and not receiving treatment. Thus, we sought to determine the impact of ADT on depression and mental and physical quality of life (QoL) in patients with both local and advanced disease using a prospective cohort study. We also wanted to determine the predictors of mental and physical QoL in men with prostate cancer. Methods ParticipantsParticipants were recruited from a single academic health sciences c...

Analysis of Brain Functions in Men with Prostate Cancer under Androgen Deprivation Therapy: A One-Year Longitudinal Study

“…The GDS scores were higher in the second assessment, implying an increase of the men who had a positive screening for depressive symptoms, but the differences were not statistically significant. This finding contrasts with previous longitudinal studies that found a higher prevalence of depression in men treated with ADT [ 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ], and in line with others, that did not confirm such a relationship [ 73 , 74 ]. Earlier studies suggested a relationship between borderline or lower testosterone levels and depressive symptoms in men [ 75 , 76 , 77 ], especially when the reduction of testosterone concentrations was longitudinal [ 78 ].…”

Evaluation and predictive factors analyses for patient-self-reported depression, anxiety and quality of life in patients with metastatic renal cell carcinoma underwent interferon-α treatment: a prospective cohort study

“…As a grievous condition and a major threat to human, cancer directly or indirectly causes mood disorders to patients as a consequence of a large reduction of life expectancy, side effect of anti-tumor drugs and a change of quality of life (11,17,18). For instance, in a recent cohort study in Indonesia, the researchers discover an obvious decline in anxiety level and an increase of QoL in oral squamous cell carcinoma patients treated by chemotherapy or invasive therapies (19).…”

The psychological impact of prostate cancer after treatment: a critical review of the literature

“…There is increasing evidence demonstrating that health and illness are much more complex, which is illustrated by the biopsychosocial model. 4 This has led to wider acknowledgement that patients whose psychological needs are met cope better with their illness.…”